By Marcus Fatunmole (Author at ICIR)
Nigerians move into the new year with many expectations ranging from improvement in the nation’s economy, security, education to health and international relations among others. They have gone through the past years with a blend of dashed hopes and democratic gains from the government. The health sector has had its fair share of the ills and growth the nation experienced since it returned to democracy on 29 May 1999.
While the past years, especially under President Muhammadu Buhari, have witnessed improved budgets and infrastructural growth in the health sector, the rate of brain drain arising primarily from poor welfare and insecurity has widened.
The International Centre for Investigative Reporting (ICIR), an independent, non-profit news agency that promotes transparency and accountability through robust and objective investigative reporting confirmed that the country has strengthened its disease surveillance system through the Nigerian Centre for Disease Control (NCDC), which provides regular disease updates for citizens. It also remains more committed to immunization and other maternal and childcare issues through the National Primary Health Care Development Agency (NPHCDA).
While it has made significant strides in curbing drug counterfeiting and production, as well as use of unapproved cosmetics in many cities in the country, the National Agency for Food and Drugs Administration and Control (NAFDAC) failed to replicate these feats in sprawling villages and settlements across the country. The lapse puts many lives at the mercy of unscrupulous elements whose greed for wealth knows no bound.
In 2020, the ICIR published an investigation on how food vendors, fruit sellers, and farmers poison Nigerians with agrochemicals.
The report, among others, exposed how NAFDAC failed to safeguard the health of Nigerians, which is the major reason it exists. Similarly, after 62 years of independence, the Federal Government provided a pathway for universal health coverage for Nigerians through the National Health Insurance Authority Bill signed into law by President Buhari in May 2022.
So, what are the issues to watch in for in the health sector in 2023?
The country has got its biggest budget ever – over a trillion naira. President Buhari signed the 2023 Appropriation Act containing N1, 075 trillion for the sector on 3 January. In the new budget, personnel cost takes N564.4 billion, overhead gulps N16.3 billion, N404 billion goes to capital projects, and the government allocates N47.6 billion to the Basic Health Care Provision Fund (BHCPF).
Others are multilateral aids and grants – N2.5 billion – and retained independent revenue N62.6 billion. How the government will implement the 2023 budget during an election year remains a concern to Nigerians.
In 2016, the Federal Government had a budget of 6.06 trillion, out of which it earmarked N550 billion for the health sector. The amount represented 4.1 per cent of the budget.
In 2017, the total budget was 7.4 trillion. The health sector got 304.1 billion, representing 4.0 per cent. Capital allocation for the year was N51.3 billion, while recurrent expenditure gulped 252.8 billion. The year 2018 saw a further decline in the percentage of the health budget to the national budget. The total federal budget was 9.1 trillion that year, from which the sector received 356.4 billion. Recurrent expenditure was 269.9 billion, while the capital budget was 86.4 billion.
In 2020, the government reduced budget allocation to the Basic Health Care Provision Fund by more than 40 per cent, from N44.4 billion to N25.5 billion. The government’s 2021 budget was 13.6 trillion. It earmarked N514 billion for the sector. Recurrent and capital took N380 billion and N134 billion, respectively. Similarly, in 2022, of the N17.1 trillion budget signed by President Buhari, the sector took N724 billion, representing 4.2 per cent of the budget.
However, the yearly budget for health by the Nigerian government did not include state and local government funds for health. They did not include funds from international development agencies such as the World Health Organization, United Nations Children Fund, United Nations Population Fund, Bill & Melinda Gates Foundation, Marie Stopes, Pathfinder International and World Bank, among others.
The ICIR also reports that the Nigerian government had consistently failed to honour the 2001 Abuja Declaration, which required all heads of government in Africa to commit 15 per cent of their annual budget to their health sector.
Maternal and child health
The World Health Organization (WHO) data shows that the neo-natal maternity rate per live 1,000 births is 35.45. The infant mortality rate (probability of dying between birth and age one per 1,000 live births is 72.24. Under-five mortality rate (probability of dying by age five per 1,000 live births) is 113.8. Meanwhile, the Nigeria Demographic and Health Survey (2018 NDHS) shows that the maternal mortality ratio is 512 deaths per 100,000 live births.
This writer notes that because of advancements in technology and further scientific breakthroughs in health, the nation should do more to save the lives of women and children in 2023.
Unlike the strike by the Academic Staff Union of Universities that crippled public universities in 2022, the health sector enjoyed relatively hitch-free services. None of the national bodies of health workers’ unions, including doctors’ unions, declared a strike. But a few, such as the Cross River State chapter of the Nigerian Medical Association, embarked on strike over the abduction of their colleagues.
Nigerians will receive uninterrupted services if workers at the facilities shun industrial action and the government meets their needs this year. Previously, the strike by different groups of professionals in the sector stalled services in public hospitals. The ICIR reported in 2021 how health professionals in the country went on strike for nearly 300 working days in eight years – 2013 and 2021.
A major concern in the sector in 2022 was the alarming rate of emigration of health professionals from the country. Multiple reports showed how doctors, medical laboratory scientists, nurses, midwives and other experts left the country in droves for jobs abroad. Many of them blamed the migration on plummeting economy, unprecedented insecurity and poor welfare. The ICIR reported how the nation lost nearly nine thousand doctors to the UK and others in two years. Other outlets have similar reports, some of which are here, here and here. Reports submitted by the ICIR in 2022 from selected hospitals across five geo-political zones on the impact of COVID-19 Intervention Fund on the facilities further attested to the high rate of doctors’ migration from the country.
Some of the facilities were the Federal Medical Centres Makurdi, Benue State, Jalingo, Taraba State, Moddibo Adama University Teaching Hospital (formerly Federal Medical Centre) Yola, Adamawa State, Obafemi Awolowo Teaching Hospital, Ile-Ife, Osun State, Federal Teaching Hospital, Abakiliki, Ebonyi State and Jos University Teaching Hospital (JUTH), Jos, Plateau State.
The Basic Health Care Provision Fund (BHCPF)
Part 1, Section 11 of the National Health Act (2014) established the BHCPF. The BHCPF is catalytic funding to improve access to primary health care. It serves to fund the Basic Minimum Package of Health Services (BMPHS), increase the fiscal space for health, strengthen the national health system, particularly at the primary health care (PHC) level by making provision for routine daily operation cost of PHCs, and ensure access to health care for all, particularly the poor, thus contributing to overall national productivity.
Some of the investigations by the ICIR on the effectiveness or otherwise of the BHCPF in 2022 are available. There is a need for increased funding for the programme, while states yet to key into the scheme should embrace it in 2023.
Disease burden: More sensitization and intervention needed
Nigeria currently leads the rest of the world in malaria burden and death, contributing about a quarter of global morbidities and fatalities from the disease.
The country has the highest burden of tuberculosis in Africa and the sixth highest in the world. Neglected Tropical Diseases need more government attention to free the country from them. Nigeria has the most NTDs globally. Non-communicable diseases (NCDs), such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, have continued to increase. The National Cancer Society claimed in 2022 that only ten cancer machines (radiotherapy machines) worked in the country.
In 2023, the government should intensify the campaign against behavioural patterns or lifestyles that promote the conditions. It should also acquire more equipment in the hospitals to combat the diseases. In 2023, the government should do more to tackle cholera, Lassa Fever and M-Pox, which have remained a yearly puzzle for the country
The government should invest more in family planning commodities and fund sex education across age groups. There should be more campaigns on the gains families derive from having the number of children they can train. More emphasis should be placed on the consequences of maintaining a large and poor family. The country’s population is currently about 200 million, with the majority living in abject poverty and lacking jobs.
Tackling malnutrition, water and sanitation
The year 2023 should witness improved attention to malnutrition. Children with acute malnutrition need care. At least 17 million children are malnourished in the country. Nigerians hope to see what the tiers of government would do to save the affected children. Besides, the government needs to increase awareness of the importance of good sanitation in the new year.
More safe water should also be available to people in the country to make the population live healthier and enjoy a happy life. In August, The ICIR reported how Kogi and Niger led other states and the Federal Capital Territory in open defecation.